Heart Disease in Firefighters: #1 Killer!

April 9, 2007
One-third of firefighter deaths so far this year appear to have been due to Cardio vascular disease! Firefighters have one on the most stressful jobs around! Many firefighters are overweight and lack adequate physical fitness, which may be contributing risk factors.Here are the statistics for the population at large:

One-third of firefighter deaths so far this year appear to have been due to Cardio vascular disease! Firefighters have one on the most stressful jobs around! Many firefighters are overweight and lack adequate physical fitness, which may be contributing risk factors.

Here are the statistics for the population at large:

  • Cardiovascular Disease, aka Coronary Heart Disease, is the number one killer in US today!
  • 950,000 Americans died last year of this silent disease.
  • It accounts for 40% of all deaths in the U.S.
  • 1 in 4 adults have CVD
  • 1 death/minute among females, 6 times all other causes combined
  • If CVD was eliminated, life expectancy would rise 7 years!
  • Stress increases blood pressure and increases morbidity and mortality of those afflicted with Cardiovascular Disease!

For Firefighters:

  • One-third of firefighter deaths so far this year appear to have been due to Cardiovascular disease!
  • Researchers believe mental stress and overexertion combined with factors such as being overweight and in poor shape may increase the risk of dying from heart disease.

Firefighters have one on the most stressful jobs around! Many firefighters are overweight and lack adequate physical fitness, which may be contributing risk factors.

What can YOU do to add years to your life?
Let's start with understanding:

What is Cardiovascular Disease?
It is the actual hardening of the arteries. This hardening is actually clogging. This clogging causes a restricted blood flow and a decrease in oxygen allowed to flow to the muscles. Then when the muscles are called on to do extra work (like pull a hose), the heart has to work all that harder. The more brittle vascular system takes a beating, and the vessels scar and clog even more.

What does it look like?
Vasoconstriction is the narrowing due to plaque and hardening. Visualize globs of chewing gum stuck to the insides of your garden hose. As the water passes through, there is less space for the flow. Heck, you guys understand flow and fluid dynamics! As time goes on, and we age and watch our nutrition less closely, the gum wads increase in size and number. Imagine these gums wads are sticky, and attract more of the same. Like they want their friends around! Flow is further restricted.

Viscosity is the thickness of a fluid, and is inversely proportional to its ability to flow. Oil is more viscous than water. Toothpaste is more viscous than oil. Jello is more viscous than toothpaste. Blood is more viscous with more fat globules in it than when it doesn't have them.

You won't believe how drastic and how fast this works! Draw blood on someone 30 minutes after having a Big Mac, fries and a milk shake. Put the blood in a vile and put a stopper in it. Let is sit for five minutes. What you see will open your eyes. Have a trash can nearby. You might feel like barfing.

The blood, when it is more viscous, has problems flowing past these plaques on the sides of the blood vessels. This makes the heart work harder to push the blood through. In essence, it wears your heart out faster.

Turbulence: as particles adhere to the walls (plaque), this increases the swirling of the blood as it passes. These further increases the resistance to flow making your heart work even harder.

Let's talk about STRESS!!!!

When a body is in a stressful situation, it adapts with the fight or flight response. This is achieved with the release of adrenaline (cortisol) from the adrenal glands. One of the effects of cortisol is vasoconstriction, which results in an increase in blood pressure, and again more work for your heart!

Firefighters enter the fight or flight/stressful situation on just about every call. People can become somewhat "used to" this and accommodate to it. But, face it, we are all human. The things you guys (and gals) see can be so incredibly tragic; a physiologic reaction cannot be avoided.


Hypertension/High Blood pressure: You guys (gals) know these numbers, but I'll put them here anyway:
140/90 high
120-139/80-89 pre-htn
119/79 normal

When was the last time you took your blood pressure? Where do you fall?

Body Mass Index is a great way to predict whether you are at risk for heart disease. You calculate it by dividing your weight in kilograms by your height in meters. It's quick and easy. People who are extremely muscular- take that into account before you are too hard on yourself. At my leanest, 12% body fat, I fall in around 25-26. But, I am extremely healthy. Take it with a grain of salt.

Range for Adult Men and Women Kg/m*
Desirable 20-24.9
Grade 1 Obesity 25-29.9
Grade 2 Obesity 30-40
Grade 3 (morbid) 40+
* - means squared

Risk Factors for Heart Disease:

Obesity: BMI - see above.

High Blood Pressure: See Above. Remember, each time you get your heart rate up by exercising, the more able your heart is to handle the rise when in a stressful situation.

Smoking: This increases your risk of CVD by 50-60%. It's an addiction, I know! But please! I smoked as a teenager and in my early 20's. Being a fitness/healthcare professional, well let's just say I have to look at myself in the mirror every day. If I am true to myself and my purpose in life, then smoking cannot be included. If I smoked, I would be telling you to do as I say, and not as I do. When you go on those calls and see the damage done to the people with COPD, I just know none of you actually smoke, right?

Genetics: Family history. I get this part- but who taught us how to eat?

Diabetes: Increases plaque in the blood vessels. It is my belief, after years of study that diabetes is on the rise, along with heart disease, because processed food causes a rise in blood sugar. Stay away from high sugar foods and processed carbohydrates- such as white flour. Eat any carbohydrate with some protein to keep the glycemic index of your food down. This will give your pancreas a break, and lesson your chances of developing DMII, and reduce your problems if you already have it.

High Cholesterol: High cholesterol is considered among the primary causes of heart disease. Cholesterol is a waxy, fat-like compound that belongs to a class of molecules called "steriods." It's found in many foods, in the bloodstream, and in all body cells. Cholesterol produces deposits in the arteries, which impedes blood flow. A handful of cholesterol might feel like a soft melted candle.

However, Some Cholesterol is needed because it is used to form and maintain cell membranes and in the manufacturing of sex hormones. It is used in the production of bile salts, aiding in digestion. And, it converts Vitamin D (with the suns help) in the skin so that our bodies can absorb calcium from our food.

Total Cholesterol and Triglycerides are monitored and should not be above certain numbers: see below.

Good Cholesterol: High-Density Lipoproteins or "HDL" is the good cholesterol. HDLs carry unneeded cholesterol away from the cells and back to the liver where it can be broken down for removal from the body. Low levels of this cholesterol is associated with an increased risk of heart disease

Bad Cholesterol: Low density Lipoproteins or LDL are bad cholesterol. LDL is considered to be a major contributor to plaque buildup in the arteries and impeded blood flow to the heart and other areas. For every 1% drop in LDL, the risk of heart attack drops by 2%.

Total cholesterol should be 200mg/dl or below.
LDL should be less than 130 mg/dl
HDL should be greater than 45 mg/dl
Triglycerides should be less than 150 mg/dl

Ratio*: LDL:HDL
Ratios: Cholesterol to HDL no higher than 4:2
LDL to HDL no higher than 2:5
*This ratio indicates your Cardiac risk factor- they reflect whether cholesterol is being deposited into the tissues or broken down and excreted.)

These Cholesterol Numbers and the Average American:

The average daily cholesterol consumption of most Americans:
males - 360 mg/day
females - 240 mg/day
The American Heart Association recommends less than 300 mg/day!


Dietary Fat:
Much of this information was found on the Website for Smart Balance Products

The body needs a certain amount of fat. If this essential fat is not eaten in the normal diet, a person will crave fat of any sort to get what the body needs. Unhealthy fat comes along with the fats that are needed. This adds fat to our bodies and clogs our arteries!

The balance of types of fat we eat is based on research done by scientists at Brandeis University. These researchers improved the ratio of HDL "good" to LDL "bad" cholesterol by using a specific balanced blend of fats as a significant part of a healthy varied diet. The American Heart Association Step 1 Diet guidelines were used. This suggests to limit total fat to 30% of calories consumed; saturated fat to under 10%; and dietary cholesterol to under 300mg per day.

This balanced fat diet provided approximately equal proportions of the three principal fatty acids: polyunsaturated, monounsaturated and saturates. It avoided the use of trans (read as hydrogenated- see your labels) fatty acids in foods and included regular exercise. Subsequent studies have increased the proportion of monounsaturates in the balance of fats.

It is my opinion that the products that Smart Balance has made based on this research is healthy, and should be considered as substitutes for any and all fatty products in one's diet. They have everything from Mayonnaise to buttery spreads and salad dressing. I use them. Even my daughter loves the peanut butter.

Not Just Fat Balance:
Essential fat can be absorbed through good nutritional sources. Here are some simple hints:

  • Limit saturated fats to 10% of calories
  • Avoid foods with hydrogenated oils and trans fatty acids in baked goods, fried foods, regular shortenings and margarine.
  • Substitute in Smart Balance Products
  • Eat a generous supply of fruits and vegetables. I recommend 5 servings per day
  • Evidence is building that Omega-3 fatty acids may be helpful in reducing heart disease risk. Eat fish two to three times per week. This will increase your Omega 3 fatty acids. Vary the type and source; try to keep to cold water fish such as salmon and sardines.
  • Eat raw nuts, never roasted or cooked. The heat they are cooked in alters the chemical make up of the oils they contain, and they can become dangerous trans fats. When raw, they are a good source of healthy oils and fiber.
  • Use oils to cook with: olive, walnut, sesame,
  • Essential Fatty Acids in supplement form are a good way to alter Cholesterol ratios. Taking them will curb your cravings for fat by giving your body what it needs.
  • Take a look at this web site: http://www.smartbalance.com/foodplan.html

12% or 250,000 deaths annually result from a lack of exercise!

How is this possible?
A 2005 study by the National Fire Protection Association showed that more than 70% of fire departments lacked fitness and health programs. Oh my gosh!

Where to start with Cardio Training:
Twelve minutes of cardio three times a week is a great place to start! Firefighters should really be doing a minimum of one hour per day of exercise. This should be a combination of cardio and resistance training. Below is a chart of how to train, alternating cardio and resistance to regain your health as a firefighter. This is by no means a training plan for taking the CPAT or any other agility test.

The step mill training is for use without, then with a weight vest. This is something you should do if you are on active duty, as you will need this more intense training. Another cardio machine could be substituted in if you do not have access to a step mill. Check with your doctor before you start this, or any exercise program. Remember- this is just to get you started!

Mentioned in the chart is circuit training. The times are mentioned because you can stop any time within a circuit. If you have problems with blood pressure and or cholesterol, ask your doctor specifically if you can train with weights before you use the recommendations here:

Click here to view the Circuit Training Chart.

Click here to view a related article on Circuit Training.

If you have questions or comments, please do not hesitate to write! Best wishes for you health!

Dr. Jen Milus, DC, CSCS



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